Antepartum Haemorrage

Question 1

what is the definition of Antepartum Haemorrhage?

Answer 1

Bleeding from or in to genital tract, usually occurs from 24 weeks of pregnancy and is prior to the birth of the baby.

Question 2

What are the most important causes for APH?

Answer 2

Placental praevia and placental abruption yet the are not the most common

Question 3

Name and define the types of placenta praevia and reference them.

With reference

Answer 3

Low lying: placenta in the mainly in the upper segment but moving slowly into lower segment

Marginal: placenta reaches but does not cover the internal os.

Partial: placenta covers the internal os when cervix is closed, but is not completely when dilated.

Total: Placenta completely covers internal os.

Hutcherson, 2017

Question 4

Name 4 SIGNS of placental abruption

Answer 4

Hypertonic uterus

Fetal Distress

uterine activity/ irritable uterus

Vaginal bleeding( which may or may not be present)

Backache (More common in a posterior implanted placenta)

Question 5

Name the 10 steps of managing an abruption?

Answer 5

Your priority is always the mother
•Call for help (Emergency Bell/ 2222)
•Left Lateral Position
•ABC (Oxygen, Sats, Bp, RR, Pulse, Temp)
•I.V. access and bloods
•Fluid resuscitation
•Indwelling Catheter
•Presenting part, fetal position and progress in labour
•Stabilize the mother
•Only then consider the baby

Question 6

Name 5 different additional investigations.

Answer 6

Blood tests- FBC, Clotting, G&S/ X-match, Kleihauer if RH Negative
•MSU & urine dipstick
•Speculum examination
•NO digital examination unless placental site confirmed as not low
•Ultrasound

Question 7

Define Placenta praevia and give reference

Answer 7

When the placenta inserts itself into the lower segment of the completly or in part. (RCOG 2011)

Question 8

Name the two new classificaitons of placenta praevia and reference.

Answer 8

Major- ,2cm from or covering cervical os

Minor- .2cm from cervical os

(RCOG, 2011)

Question 9

Name the 11 steps of managing placenta praevia?

Answer 9

Your priority is always the mother
•Call for help (Emergency Bell/ 2222)
•Left Lateral Position
•ABC (Oxygen, Sats, BP, RR, Pulse, temp)
•I.V. access and bloods.  (Cross matched blood should be readily available.  Cell salvage.
•Fluid resuscitation
•Indwelling Catheter
•Presenting part and fetal position
•USS
.Stabilize the mother
•Only then consider the baby

Question 10

Name the 8 management of severe APH?

Answer 10

Catheterise (urometer)
•Strict fluid balance
•Involvement of Haematologist
•May need blood products
•Emergency LSCS when stable
•May need a central line (CVP)
•In the case of uterine rupture or morbidly adherent placenta Possible Hysterectomy
•DOCUMENTATION

Question 11

Define what Vasa Praevia is.

Answer 11

occurs when a fetal blood vessel within the membranes covers the cervical os ahead of the presenting part. Often associated with a velamentous insertion of the cord or succenturiate lobe.

Question 12

Define Uterine rupture

Answer 12

Rupture of an unscarred uterus or dehiscence of a previous uterine scar

Question 13

Name the three types of uterine rupture.

Answer 13

Complete: rupture involves the full thickness of the uterine wall and pelvic peritoneum
•Incomplete (silent): involves the myometrium but not the pelvic peritoneum
•Scar dehiscence: thinning or tearing of the uterine wall along an old scar